Stability of Retrospective Pregnancy Intention Reporting Among Women with Unwanted Pregnancies in the United States

Abstract

Objectives Retrospective assessment of pregnancy intention may be unreliable as women’s perceptions of a past conception can change over time. We compared the stability of retrospective pregnancy intention reporting over 5 years among women who sought and either received, or were denied, an abortion. Methods We recruited women from 30 abortion facilities across the United States in 2008–2010. Participants, some who received abortions and others who were denied care because they presented beyond facilities gestational limits, were followed prospectively for 5 years (n = 827). At enrollment and semiannually from year-2 to year-5, women completed the London Measure of Unplanned Pregnancy (LMUP), a six-item measure (scored 0–12), regarding the index pregnancy. We used multivariable mixed-effects models to assess the stability of retrospective reports of index pregnancy intendedness and compared trajectories by group, accounting for site and participant clustering. Our hypotheses were that intention would tend towards “more intended” over time among women denied abortions, who carried the pregnancies to term, and remain stable among women who received the abortion. Results Baseline LMUP scores were low (mean: 2.8) and similar by study group. Scores increased among women denied the abortion by year-2 (from 2.9 to 3.5; p < 0.001) and were steady through year-5. For women having near-limit abortions, reported intentions were steady between baseline (mean: 2.7) and year-2 (2.8), and declined thereafter through year-5 (to 2.5; p < 0.001). Conclusions Women somewhat shifted their perceptions of their intentions in correspondence with the pregnancy outcome. Retrospective estimates may underestimate the degree to which births result from unintended pregnancy.

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Notes

  1. 1.

    At baseline, study interviewers perceived that participants incorrectly understood item-6 regarding pregnancy preparatory behaviors. Although the item asks only about behaviors conducted specifically to prepare for pregnancy, participants were reporting whether they had engaged in the behavior for any reason. As a result, we added an interviewer prompt to clarify the item’s meaning. We excluded from analysis responses to item-6 prior to the addition of the prompt.

  2. 2.

    We modeled summed LMUP score as the outcome, rather than using a latent growth model examining latent scores to items, due to the complexity of our longitudinal model. Modeling a Generalized Linear Latent and Mixed Model with three-category outcomes, three study groups, group-by-time interactions, a spline, three levels of hierarchy, and a random time effect was too computationally intensive. Our approach of using summed LMUP scores likely produced very similar results as would have the more complex approach.

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Acknowledgements

The authors thank Rana Barar, Heather Gould, and Sandy Stonesifer for study coordination and management; Mattie Boehler-Tatman, Janine Carpenter, Undine Darney, Ivette Gomez, Selena Phipps, Brenly Rowland, Claire Schreiber and Danielle Sinkford for conducting interviews; Michaela Ferrari, Debbie Nguyen and Elisette Weiss for project support; Jay Fraser and John Neuhaus for database and statistical assistance; and all the participating providers for their assistance with recruitment.

Funding

This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Office of Research on Women’s Health, Building Interdisciplinary Research Careers in Women’s Health Grant #K12 HD052163; the Wallace Alexander Gerbode Foundation; an anonymous foundation; and the David and Lucile Packard Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Correspondence to Corinne H. Rocca.

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Rocca, C.H., Wilson, M.R., Jeon, M. et al. Stability of Retrospective Pregnancy Intention Reporting Among Women with Unwanted Pregnancies in the United States. Matern Child Health J 23, 1547–1555 (2019). https://doi.org/10.1007/s10995-019-02782-9

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Keywords

  • Abortion
  • Pregnancy intention
  • Reliability
  • Retrospective measurement
  • Stability
  • Unintended pregnancy